Medicare Diabetes Prevention Program Faces Low Enrollment and Operational Challenges
The Medicare Diabetes Prevention Program (MDPP), launched in April 2018, aimed to reduce the incidence of diabetes among 16 million eligible overweight or obese Medicare beneficiaries with prediabetes by promoting diet, exercise, and lifestyle changes.
Despite its potential to save billions in healthcare costs by preventing diabetes, participation has been remarkably low, with only 9,015 enrollees after six years—less than 1% of eligible individuals. Physicians involved in diabetes prevention research have expressed surprise at the minimal patient engagement with the program.
The MDPP includes 22 sessions of educational workshops conducted by trained coaches, with Medicare providing payments to qualified providers based on attendance and weight loss achievements. However, CMS reports reveal that Medicare spending on the program has been under $1 million for roughly 3,480 fee-for-service beneficiaries, with average payments per individual well below the maximum levels. Providers cited administrative burdens, including time-consuming billing and reporting requirements, as significant barriers to broader implementation.
Additional challenges limiting enrollment include providers not ordering requisite blood tests to diagnose prediabetes, lack of program awareness among healthcare professionals, and restricted inclusion of the MDPP in some Medicare provider networks. The COVID-19 pandemic further constrained participation by impeding in-person sessions, though CMS has since adapted policies to allow virtual attendance and remote weight verification, which could enhance accessibility.
CMS has implemented several rule changes, such as allowing the program to be completed within one year instead of two and extending virtual participation options to all beneficiaries starting in 2024. These adjustments aim to boost enrollment and program adherence. The influential role of healthcare providers in referring patients to the MDPP is evident, with half of participants receiving referrals from primary care physicians or specialists.
Despite demonstrated clinical effectiveness in reducing diabetes onset and associated healthcare expenditures, the MDPP continues to struggle with scalability and engagement. Provider groups and health systems call for increased reimbursement to address operational costs and streamlined administrative processes to improve program adoption. As Medicare seeks to expand preventive care services, resolving these challenges remains critical to realizing the MDPP’s potential for improving outcomes and reducing the economic burden of diabetes among older adults.